摘要
目的改进全身炎症反应综合征（SIRS）的治疗方法及对肾功能的影响。方法SIRS患者110例随机分为两组，对照组（n=57）按常规治疗；治疗组（n=53）加用以下措施保护炎症靶器官（肠道、肺脏及胰腺）：①生大黄30g，水煎成200mL溶液（水煎15min），分2次／d口服或管饲；②盐酸氨溴索60mg，ivgtt，Bid；③乌司他丁40万U，iv，Q8h。疗程5d。动态监测胃黏膜pH值（pHi）、氧合指数（PaO2／FiO2）、血清淀粉酶（AMY）和血清半胱氨酸蛋白酶抑制剂C（Cys—C）的变化，分别评估肠道、肺脏、胰腺及肾功能。结果治疗组肾功能障碍发生率明显下降（49．1％vs68．4％，P〈0．05），急性肾衰竭发生率及病死率均未见明显降低（34．0％vs47．4％，39．6％vs54．4％，P〉0．05）。治疗组各项指标在治疗后第5～7天较对照组改善更明显（P〈0．05或P〈0．01）。治疗组血清Cys—C的变化与pHi及PaO2／FiO2的变化均呈显著负相关，与血清淀粉酶（AMY）的变化呈显著正相关。结论加强保护炎症靶器官对SIRS患者的肾功能具有一定程度的保护作用。
Objective To improve the therapy of systemic inflammatory response syndrome （SIRS） and to observe the effect on renal function. Methods 110 patients with SIRS were randomly divided into treatment group（ n = 53 ） and control group （ n = 57 ）. Both groups were given routine treatment, while those in the treatment group were given oral Rhubarb 30 g, decoction, twice a day; Ambroxol hydrochloride （60 mg,ivgtt,Bid） ; Ulinastatin （400 000 U,iv,Q8h） ,the therapy lasted for 5 days to protected the inflammatory target organs included intestine, lung and pancreas. Gastric intramucosal pH （ phi ） , PaO2/FIO2, amylase（ AMY）, serum cystatin C （Cys -C ） were monitored to evaluate the function of intestine, lung, pancreas and renal. Results The incidence rate of renal dysfunction was lower in the treatment group （49.1% vs. 68.4% ,P 〈0.05 ） ,while there were no statistical differences in the incidence rate of acute renal failure and mortality rate （ 34.0% vs. 47.4% ,39.6% vs. 54.4% ,P 〉 0.05 ）. From the 5th day to 7th day after the treatment in the treatment group, all the monitoring indexes were improved significantly （ P 〈 0.05 or P 〈 0.01 ）. Serum Cys - C in the treatment group was negative correlation with pHi and PaO2/FiO2, but positive correlation with serum AMY. Conclusion Protection of the target organ has an important role in renal function of patients with SIRS.
出处
《中国急救医学》
CAS
CSCD
北大核心
2009年第3期246-248,共3页
Chinese Journal of Critical Care Medicine
